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Patients with diabetic neuropathy are prone to ulceration on the sole of the foot, especially in areas with high weight-bearing pressure. The relationship between weight-bearing pressure and nutritive skin circulation in the plantar region was studied. Gait analysis was performed with the EMED Gait Analysis System and the skin circulation was measured by fluorescein flowmetry in ten neuropathic diabetic patients and in eight healthy controls. The critical plantar foot pressure above which nutritional blood flow in the skin was arrested was 3 N cm-2 or more in both diabetic and control subjects. Below 3 N cm-2 the blood flow was independent of weight-bearing pressure both in diabetic and control subjects (correlation coefficient r = -0.01 and -0.19, respectively). Thus, our results indicate that the nutritional blood flow in the plantar region is not decreased in patients with diabetic neuropathy.

Titrating depth of desflurane anesthesia using AAItrade mark-index guidance decreased main anesthetic consumption and improved emergence during spine surgery.

Necrosis of the nipple after a reduction mammaplasty with transposition of the nipple is a serious complication. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 16 patients undergoing reduction mammaplasty according to the method of McKissock, the skin circulation was measured in both breasts by laser Doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 245.7 +/- 39.3% of the preoperative blood flow (100%) (mean +/- SEM, p less than 0.01). When 40 ml of 0.25% adrenaline was injected into the incision lines, the corresponding increase in blood flow was 153.4 +/- 15.6% (p less than 0.01). After the medical and lateral glandular resections the blood flow in the nipple of the vertical dermal pedicle was 125.6 +/- 21.2% of the preoperative blood flow and when adrenaline was given the corresponding value was 79.3 +/- 6.5%. After the skin had been sutured, the blood flow was 128.4 +/- 25.9% of the preoperative value and in the breast in which adrenaline was injected it was 177 +/- 96.9%. One to four days postoperatively the blood flow was 123.1 +/- 19.9% of the preoperative value and in the breast that received adrenaline 130 +/- 24%. At FF homogeneous fluorescence was observed in the nipple postoperatively in all patients but one; in this patient avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the McKissock method is adequate.